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The treatment plan for airway dissemination of lung adenocarcinoma can be understood and examined

时间：2026-04-21　人气：

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Overview of the condition

After Mr. Zheng was diagnosed with a malignant lung lesion, he underwent a VATS right upper lung lobectomy and mediastinal lymph node dissection under general anesthesia on August 20, 2020.

Postoperative pathology revealed infiltrating adenocarcinoma of the right upper lobe, with visible papillary and micro-papillary structures, measuring approximately 3.2cm*3cm. Airway dissemination and intravascular cancer thrombus were observed. No invasion of visceral pleura was found, and no cancer invasion was observed at the bronchial and vascular cut ends. Cancer metastasis was seen in the R2/R4 lymph nodes (2/2, 2/3). Genetic testing indicated EGFR 21 mutation. No chemotherapy was administered postoperatively, and the patient was treated with oral targeted therapy with Osimertinib at a dose of 80mg per day.

Department

Xiao

knowledge

VATS Lobectomy - Thoracoscopic Lobectomy

Thoracoscopic lobectomy refers to the surgical removal of a lung lobe with the assistance of thoracoscope. During the operation, the surgeon can observe the situation inside the chest through a television screen and complete the surgical procedure through different hole-like incisions, separating and ligating the pulmonary arteriovenous and bronchial structures, thereby completely removing the affected lung lobe. For malignant tumors, the hilar and mediastinal lymph nodes should also be evaluated.

Traditional surgery involves large incisions, high incidence of postoperative complications, and unclear treatment effects. The thoracotomy lobectomy used in the past can remove the lesion, thoroughly clean and drain the lymph nodes, and help prolong the survival time of patients with early-stage lung cancer. However, this surgery causes significant trauma and seriously affects the patient's cardiopulmonary function.

With the deepening of research, VATS lobectomy has gradually been applied to clinical treatment. Current clinical studies show that VATS lobectomy is an effective method for treating early-stage lung cancer, with advantages such as minimal trauma, rapid postoperative recovery, and few complications, which is beneficial for early recovery exercise of lung function. With the development and promotion of thoracoscopic technology, VATS lobectomy has been widely applied in the treatment of lung cancer, with significant therapeutic effects.

Mr. Zheng completed the surgery and received oral targeted drug therapy, but he was still very worried about recurrence. After learning from various sources, Mr. Zheng and his family, recommended by friends, learned about Professor Zhang Minghui's vNKT technology at Tsinghua University School of Medicine, and carefully reviewed the displayed cases of vNKT cell therapy, particularly hoping to try it to delay the occurrence of recurrence and metastasis.

After reviewing Mr. Zheng's medical records, Professor Zhang Minghui made the following analysis and judgment:

1. The patient has undergone lung cancer surgery, with lymph node metastasis visible during the operation, indicating a late stage.

2. The patient's tumor presents risk factors such as lymphatic metastasis, intravascular cancer thrombus , and intrapulmonary dissemination . Currently, the patient is only receiving oral targeted therapy, which is prone to drug resistance.

3. vNKT therapy utilizes powerful immune cells to eliminate tumor cells that may remain undetected in the body, with essentially no side effects. Combined vNKT and targeted therapy can effectively control the tumor .

Mr. Zheng decided to undergo vNKT cellular immunotherapy in April 2021, with a regimen of one course per two months. As of April 2023, 13 courses have been completed, and subsequent multiple follow-up examinations have shown no signs of recurrence or metastasis symptoms .

Image Aspects

Tumor markers

Month

CEA, CA19-9: within normal range during follow-up from November 2020 to March 2023;

SCCA: slightly above normal range in February 2021, and within normal range during follow-up in August 2021 and March 2023.

Conclusion and Comments

Mr. Zheng's quality of life has greatly improved. My mental state is very good, and I feel more energetic in doing things than before, returning to my pre illness state. Normal life and work have not been affected by illness.

Mr. Zheng achieved the expected effect after using vNKT cell therapy. After two years, the latest evaluation result is still stable and no progress has been made. Immunotherapy is considered one of the most promising directions in tumor treatment, and Mr. Zheng's case illustrates this point very well.

In recent years, research on STAS (airway spread) has mainly focused on the influence of STAS on lung adenocarcinoma and some tumor related factors. The incidence of STAS in lung adenocarcinoma ranges from 14.8% to 56.4%; In a study, it was found that the incidence of STAS in lung adenocarcinoma dominated by micropapillary type was the highest (91.3%), with extensive STAS being the main type< H328>^[¹^]。

In a recent study involving 383 cases of stage IA and 161 cases of stage IB lung adenocarcinoma, patients with STAS positivity showed significant deterioration in their condition, with poorer RFS and overall survival (OS) compared to those with STAS negativity< H347>^[2^]。. Kadota K and other surgical methods were used to verify the relationship between the prognosis of early lung adenocarcinoma and STAS status. In this large cohort study involving 411 cases of stage I lung adenocarcinoma, researchers found that positive STAS patients who underwent limited resection had higher rates of distant and local recurrence than STAS negative patients; In multivariate analysis, the presence ofSTAS is independently associated with the risk of recurrence^[3^].

Mr. Zheng had risk factors such as lymph node metastasis, airway dissemination, and vascular cancer thrombus after lung cancer surgery. In order to achieve long-term stability, vNKT cell therapy was chosen and the expected effect was achieved. During this process, vNKT cell immunotherapy plays an indispensable role in reducing the risk of recurrence and metastasis and strengthening the immune system, thereby providing patients with long-term stability.

References:

[1] Warth A, Muley T, Kossakowski CA, et al. Prognostic Impact of Intra-alveolar Tumor Spread in Pulmonary Adenocarcinoma [J]. The American Journal of Surgical Pathology, 2015, 39(6): 793-801

[2] Dai C, Xie H, Su H, et al. Tumor Spread through Air Spaces Affects the Recurrence and Overall Survival in Patients with Lung Adenocarcinoma >2 to 3 cm[J]. Journal of Thoracic Oncology: OfficialPublication of the International Association for the Study of Lung Cancer, 2017, 12(7): 1052-1060

[3] Kadota K, Nitadori J, Sima CS, et al. Tumor Spread through Air Spaces is an Important Pattern of Invasion and Impacts the Frequency and Location of Recurrences after Limited Resection for Small Stage I Lung Adenocarcinomas [J]. Journal of Thoracic Oncology: Official Publication of the International Association for the Study of Lung Cancer, 2015, 10(5): 806-814

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The treatment plan for airway dissemination of lung adenocarcinoma can be understood and examined

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